Medical Minute 5-27: Play Ball! Saving a Young Girl's Leg

15-year-old Olivia Warhop would prefer to spend her time in a pool or on a soccer field instead of in therapy.

"It's very hard for her because she's very active…and an athlete," said Lori Warhop.

"They talked about it as a donor bone, and I thought, 'OK, what exactly does that mean?'"

Doctor Michael Joyce says bones can be donated and transplanted from deceased patients -- just like organs.

"The only real reason Olivia was able to have this operation is because we had a bone that was donated by someone else.," said Michael Joyce, M.D., Orthopedic Surgeon Cleveland Clinic Cleveland, OH.

First, doctors had to measure the size of Olivia's bone. They then contacted bone and tissue banks to find a suitable match. The donated bone was stripped, cleaned and processed. Surgeons implanted the new "dead" bone against the existing "living" bone. The patient's own bone will grow into and begin to replace the transplanted bone.

"The goal is to provide a reconstruction that is a biological implant."

Because the transplanted bones are dead and frozen -- patients have a much lower chance of rejecting them. Doctor Joyce says 85% of the time, they have a good outcome. In this X-ray, you can see Olivia's new bone. And like any true athlete, she's happy to show off her battle scar -- 135 stitches later.

"I have no pain…never."

"We're just waiting for the bone to heal, so she can get back to soccer."

For this brave young athlete, that day can't come quick enough.

For more information on other series produced by Ivanhoe Broadcast News contact John Cherry at (407) 691-1500, jcherry@ivanhoe.com.

BACKGROUND: Bone cancer, also known as bone tumors, is a form of cancer caused by an abnormal growth in the bone’s cells. These tumors can be benign or malignant and are commonly found to affect children and adolescents. Bone tumors often arise in areas of the bone that experience rapid growth. An estimated 2,650 people were diagnosed with bone cancer in 2010, and 1,460 sufferers died. Although the reasons for developing bone cancer are unknown, some possible causes include genetic mutations, radiation, and trauma.

SYMPTOMS: It is vital to recognize the symptoms of bone cancer, especially if there has been some sort of trauma or injury to the bones. Some signs of a potential cancerous growth include:• Bone fractures, even from a slight injury• Pain in the bones that might worsen at night• Occasionally, a mass and swelling that you can feel at the tumor siteNote: Some benign tumors have no symptoms.

(SOURCE: www.ncbi.nlm.nih.gov/)

DONOR BONE: Patients suffering from bone cancer have options when considering their preferred form of treatment. One option that is proving to be extremely effective is using donor bone (bone donated from cadavers). The dead bone is implanted into the patient’s body against their living bones. Over time, the framework provided by the dead bone enables the living bone to grow; the bones heal together.

ADVANTAGES: When compared to grafting a living bone from within the patient’s body, there are some advantages to using a donor bone. • More economical: Donor bones are less expensive than grafting a living bone from the patient. Generally, bones used to graft are taken from the hip. Although the fusion rate of using the patient’s living bone is slightly better, surgical expenses are costly.• Less time consuming: The patient saves time by forgoing an additional surgery.• Less pain and fewer complications: The risk of having an infection, hematomas, and fractures are not as significant when using a donor bone. Also, there is less pain since there is only one surgery site. (SOURCE: www.back.com/faq.html)

POTENTIAL RISKS: As with most surgical procedures, there are potential risks to be considered. Since the donor bone is from a cadaver, it does not contain any living cells; this incompatibility could pose re-absorption problems, and the bone could be rejected. Although all donated bones are carefully treated, there is still a small chance of disease transmission. Also, it also may take longer for the donated bone to achieve a solid fusion as compared to a living bone from the patient. (SOURCE: www.back.com/faq.html)

________________________________________________THE FOLLOWING IS AN IN-DEPTH INTERVIEW WITH THE DOCTOR FROM THE STORY ABOVE:

Michael Joyce, M.D, an orthopedic surgeon from the Cleveland Clinic, talks about helping kids with bone cancer. Why was Olivia’s case in particular so rare?

Dr. Joyce: Primary bone tumors that are cancers are rare in general. There are about 3,000 malignant bone tumors that present themselves each year in the United States. So if we go through the different types of bone tumors, the most common for this age group would be an osteosarcoma. In her case, this did not have markers of producing bone; so when we looked at the tissue, this produces muscle – fibrous tissue – but not bone. We call it a myofibroblastic sarcoma bone.

Furthermore, what about the length of resection was unusual?

Dr. Joyce: Well, this length of resection was about 18 cm. So there are times where we have small gaps in the bone where we can just fill it in with bone graft. This situation required a structural graft (structural meaning someone else’s bone). And then the question comes up: Where do we get that bone? Olivia was able to have this operation because we had a bone that was donated by someone else. So at the time of crisis, a family member passes away and often times that individual had made a decision to donate organs and tissue – in this particular case bone. Or it is a situation where family members have to make a decision that they want to make the best of this unfortunate situation for their loved one. So it takes some courage. There is a lot of interaction with the nurses as well as the individual who coordinates the donation for the organ recovery agencies that exist in the United States. They interact with the family and explain the donation of the tissues and organs. Typical organs would be heart, kidneys, liver, lungs and (sometimes) pancreas and bowel. For tissues it could be corneas, heart valves, skin, and in this specific case it would be tendons and bone.

In Olivia’s case, did her transplant have to come from another pediatric patient?

Dr. Joyce: It doesn’t necessarily need to be another pediatric donor. It needs to be another donor that matches her size of bone. You don’t want to put a huge bone in for a situation that called for a more narrow bone. There are tissue banks in the United States that are established and accredited, not only by the American Association Tissue Banks but also inspected by the Food and Drug Administration (FDA). The tissue banks store these bones – deeply frozen (minus 70 degrees centigrade) and have x-rays of the bone for sizing. . So from Olivia, I can size what her bone needs to be – the length is as well as the width – and then look around and inquire with different tissue banks about the exact size. They will then provide me something that is very close (perhaps not exact). There is a lot of preoperative planning to match the size of the bone for the particular patient.

Is there anything that you would like to add?

Dr. Joyce: Well, again I would add that if it wasn’t for the altruistic, generous donation of the tissues by loving people in our population at a time of crisis when a loved one dies, we wouldn’t be able to perform the operation that saved Olivia’s leg . . . and moreover she would not be here today to share that story with you.

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